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Other Hallucinogen Intoxication
DSM-IV In DSM-IV, this disorder is called Hallucinogen Intoxication For more information, see Substance Intoxication The essential feature of Hallucinogen Intoxication is the presence of clinically significant maladaptive behavioral or psychological changes (e.g., marked anxiety or depression, ideas of reference, fear of losing one's mind, paranoid ideation, impaired judgement, or impaired social or occupational functioning) that develop during, or shortly after (within minutes to a few hours), hallucinogen use (Criteria A and B). Perceptual changes develop during or shortly after hallucinogen use and occur in a state of full wakefulness and alertness (Criterion C). These changes include subjective intensification of perceptions, depersonalization, derealization, illusions, hallucinations, and synesthesias. In addition, the diagnosis requires that two of the following physiological signs are also present: pupillary dilation, tachycardia, sweating, palpitations, blurring of vision, tremors, and incoordination (Criterion D). The symptoms must not be due to a general medical condition and are not better accounted for by another mental disorder (Criterion E). Hallucinogen Intoxication usually begins with some stimulant effects such as restlessness and autonomic activation. Nausea may occur. A sequence of experiences then follows, with higher doses producing more intense symptoms. Feelings of euphoria may alternate rapidly with depression or anxiety. Initial visual illusions or enhances sensory experiences may give way to hallucinations. At low doses, the perceptual changes frequently do not include hallucinations. Synesthesias (a blending of senses) may result, for example, in sounds being "seen." The hallucinations are usually visual, often of geometric forms or figures, sometimes of persons and objects. More rarely auditory or tactile hallucinations are experiences. In most cases, reality testing is preserved (i.e., the individual knows that the effects are substance induced). Diagnostic Criteria A'''. Recent use of a hallucinogen. '''B. Clinically significant maladaptive behavioral or psychological changes (e.g., marked anxiety or depression, ideas of reference, fear of losing one's mind, paranoid ideation, impaired judgement, or impaired social or occupational functioning) that developed during, or shortly after, hallucinogen use. C'''. Perceptual changes occurring in a state of full wakefulness and alertness (e.g., subjective intensification of perceptions, depersonalization, derealization, illusions, hallucinations, synesthesias) that developed during, or shortly after, hallucinogen use. '''D. Two (or more) of the following signs, developing during, or shortly after, hallucinogen use: # pupillary dilation # tachycardia # sweating # palpitations # blurring of vision # tremors # incoordination E'''. The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder. DSM-5 '''Diagnostic Criteria A'''. Recent use of a hallucinogen (other than phencyclidine). '''B. Clinically significant problematic behavioral or psychological changes (e.g., marked anxiety or depression, ideas of reference, fear of "losing one's mind," paranoid ideation, impaired judgement) that developed during, or shortly after, hallucinogen use. C'''. Perceptual changes occurring in a state of full wakefulness and alertness (e.g., subjective intensification of perceptions, depersonalization, derealization, illusions, hallucinations, synesthesias) that developed during, or shortly after, hallucinogen use. '''D. Two (or more) of the following signs developing during, or shortly after, hallucinogen use: # Pupillary dilation. # Tachycardia. # Sweating. # Palpitations. # Blurring of vision. # Tremors. # Incoordination. E'''. The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication with another substance. '''Differential Diagnosis Other substance intoxication Other hallucinogen intoxication should be differentiated from intoxication with amphetamines, cocaine, or other stimulants; anticholinergics; inhalants; and phencyclidine. Toxicological tests are useful in making this distinction, and determining the route of administration may be useful. Other conditions Other disorders and conditions to be considered include schizophrenia, depression, withdrawal from other drugs (e.g., sedatives, alcohol), certain metabolic disorders (e.g., hypoglycemia), seizure disorders, tumors of the central nervous system, and vascular insults. Hallucinogen persisting perception disorder Other hallucinogen intoxication is distinguished from hallucinogen persisting perception disorder because the symptoms in the latter continue episodically or continuously for weeks (or longer) after the most recent intoxication. Other hallucinogen-induced disorders Other hallucinogen intoxication is distinguished from the other hallucinogen-induced disorders (e.g., hallucinogen-induced anxiety disorder, with onset during intoxication) because the symptoms in these latter disorders predominate the clinical presentation and are severe enough to warrant independent clinical attention.